As to the efficiency side of things...I guess I shouldn't complain too much, as StukaSpouse is currently making pretty good money just managing all the paperwork required for the Medicare patients at the nursing home she works for. That's a *ton* of paperwork, all going to verify that all things are being done per regulation.

But that's being done at the nursing home, so it shows up as their expense. That lets Medicare claim low administrative overhead - they're not directly paying StukaSpouse. Political posturing triumphs over reality.